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Abstract：
Invasive non-typhoidal Salmonella (iNTS) disease is a significant health concern in sub-Saharan Africa. While our knowledge of a larger-scale variation is growing, understanding of the subnational variation in iNTS disease occurrence is lacking, yet crucial for targeted intervention.
We performed a systematic review of reported occurrences of iNTS disease in sub-Saharan Africa, consulting literature from PubMed, Embase and Web of Science published since 2000. Eligibility for inclusion was not limited by study type but required that studies reported original data on human iNTS diseases based on the culture of a normally sterile site, specifying subnational locations and the year, and were available as full-text articles. We excluded studies that diagnosed iNTS disease based on clinical indications, cultures from non-sterile sites or serological testing. We estimated the probability of occurrence of iNTS disease for sub-Saharan Africa on 20 km × 20 km grids by exploring the association with geospatial covariates such as malaria, HIV, childhood growth failure, access to improved water, and sanitation using a boosted regression tree.
We identified 130 unique references reporting human iNTS disease in 21 countries published from 2000 through 2020. The estimated probability of iNTS occurrence grids showed significant spatial heterogeneity at all levels (20 km × 20 km grids, subnational, country and subregional levels) and temporal heterogeneity by year. For 2020, the probability of occurrence was higher in Middle Africa (0.34, 95% CI: 0.25 to 0.46), followed by Western Africa (0.33, 95% CI: 0.23 to 0.44), Eastern Africa (0.24, 95% CI: 0.17 to 0.33) and Southern Africa (0.08, 95% CI: 0.03 to 0.11). Temporal heterogeneity indicated that the probability of occurrence increased between 2000 and 2020 in countries such as the Republic of the Congo (0.05 to 0.59) and Democratic Republic of the Congo (0.10 to 0.48) whereas it decreased in countries such as Uganda (0.65 to 0.23) or Zimbabwe (0.61 to 0.37).
The iNTS disease occurrence varied greatly across sub-Saharan Africa, with certain regions being disproportionately affected. Exploring regions at high risk for iNTS disease, despite the limitations in our data, may inform focused resource allocation. This targeted approach may enhance efforts to combat iNTS disease in more affected areas.
We performed a systematic review of reported occurrences of iNTS disease in sub-Saharan Africa, consulting literature from PubMed, Embase and Web of Science published since 2000. Eligibility for inclusion was not limited by study type but required that studies reported original data on human iNTS diseases based on the culture of a normally sterile site, specifying subnational locations and the year, and were available as full-text articles. We excluded studies that diagnosed iNTS disease based on clinical indications, cultures from non-sterile sites or serological testing. We estimated the probability of occurrence of iNTS disease for sub-Saharan Africa on 20 km × 20 km grids by exploring the association with geospatial covariates such as malaria, HIV, childhood growth failure, access to improved water, and sanitation using a boosted regression tree.
We identified 130 unique references reporting human iNTS disease in 21 countries published from 2000 through 2020. The estimated probability of iNTS occurrence grids showed significant spatial heterogeneity at all levels (20 km × 20 km grids, subnational, country and subregional levels) and temporal heterogeneity by year. For 2020, the probability of occurrence was higher in Middle Africa (0.34, 95% CI: 0.25 to 0.46), followed by Western Africa (0.33, 95% CI: 0.23 to 0.44), Eastern Africa (0.24, 95% CI: 0.17 to 0.33) and Southern Africa (0.08, 95% CI: 0.03 to 0.11). Temporal heterogeneity indicated that the probability of occurrence increased between 2000 and 2020 in countries such as the Republic of the Congo (0.05 to 0.59) and Democratic Republic of the Congo (0.10 to 0.48) whereas it decreased in countries such as Uganda (0.65 to 0.23) or Zimbabwe (0.61 to 0.37).
The iNTS disease occurrence varied greatly across sub-Saharan Africa, with certain regions being disproportionately affected. Exploring regions at high risk for iNTS disease, despite the limitations in our data, may inform focused resource allocation. This targeted approach may enhance efforts to combat iNTS disease in more affected areas.
摘要：
背景：侵袭性非伤寒沙门氏菌（iNTS）疾病是撒哈拉以南非洲的一个重要健康问题。虽然我们对更大规模变化的认识在增长，缺乏对iNTS疾病发生的国家以下差异的理解，但对于有针对性的干预至关重要。
方法：我们对撒哈拉以南非洲的iNTS疾病的报告发生率进行了系统评价，来自PubMed的咨询文献，Embase和WebofScience自2000年以来出版。纳入的资格不受研究类型的限制，但要求研究报告基于正常无菌部位的培养的人类iNTS疾病的原始数据，指定国家以下地区的地点和年份，并作为全文文章提供。我们排除了根据临床适应症诊断iNTS疾病的研究，来自非无菌部位或血清学测试的培养物。我们通过探索与疟疾等地理空间协变量的关联，在20km×20km的网格上估计了撒哈拉以南非洲发生iNTS疾病的可能性，艾滋病毒,童年成长失败，获得改善的水，和卫生设施使用增强回归树。
结果：我们确定了从2000年到2020年发表的21个国家的130个报告人类iNTS疾病的独特参考文献。iNTS发生网格的估计概率在各级显示出显著的空间异质性(20km×20km网格，国家以下,国家和次区域层面)和按年份划分的时间异质性。2020年，中部非洲发生的概率较高(0.34，95%CI：0.25至0.46)，其次是西非(0.33，95%CI：0.23至0.44)，东非（0.24，95%CI：0.17至0.33）和南部非洲（0.08，95%CI：0.03至0.11）。时间异质性表明，在2000年至2020年期间，刚果共和国(0.05至0.59)和刚果民主共和国(0.10至0.48)等国家的发生概率增加，而乌干达(0.65至0.23)或津巴布韦(0.61至0.37)等国家的发生概率下降。
结论：整个撒哈拉以南非洲地区的iNTS疾病发病率差异很大，某些地区受到不成比例的影响。探索iNTS疾病高危地区，尽管我们的数据有限，可以通知集中的资源分配。这种有针对性的方法可能会加强在受影响地区抗击iNTS疾病的努力。
方法：我们对撒哈拉以南非洲的iNTS疾病的报告发生率进行了系统评价，来自PubMed的咨询文献，Embase和WebofScience自2000年以来出版。纳入的资格不受研究类型的限制，但要求研究报告基于正常无菌部位的培养的人类iNTS疾病的原始数据，指定国家以下地区的地点和年份，并作为全文文章提供。我们排除了根据临床适应症诊断iNTS疾病的研究，来自非无菌部位或血清学测试的培养物。我们通过探索与疟疾等地理空间协变量的关联，在20km×20km的网格上估计了撒哈拉以南非洲发生iNTS疾病的可能性，艾滋病毒,童年成长失败，获得改善的水，和卫生设施使用增强回归树。
结果：我们确定了从2000年到2020年发表的21个国家的130个报告人类iNTS疾病的独特参考文献。iNTS发生网格的估计概率在各级显示出显著的空间异质性(20km×20km网格，国家以下,国家和次区域层面)和按年份划分的时间异质性。2020年，中部非洲发生的概率较高(0.34，95%CI：0.25至0.46)，其次是西非(0.33，95%CI：0.23至0.44)，东非（0.24，95%CI：0.17至0.33）和南部非洲（0.08，95%CI：0.03至0.11）。时间异质性表明，在2000年至2020年期间，刚果共和国(0.05至0.59)和刚果民主共和国(0.10至0.48)等国家的发生概率增加，而乌干达(0.65至0.23)或津巴布韦(0.61至0.37)等国家的发生概率下降。
结论：整个撒哈拉以南非洲地区的iNTS疾病发病率差异很大，某些地区受到不成比例的影响。探索iNTS疾病高危地区，尽管我们的数据有限，可以通知集中的资源分配。这种有针对性的方法可能会加强在受影响地区抗击iNTS疾病的努力。
