title: Leptospirosis in Sub-Saharan Africa: a systematic review.
abstract: BACKGROUND
  Leptospirosis 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Information 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 Data are unavailable or outdated for many countries, particularly those in Central Africa.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.
  
  
  CONCLUSIONS
  A 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.
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1100 DE, room F4-220, Amsterdam, Netherlands.
authors.forename: Sophia G
authors.initials: SG
authors.lastname: de Vries
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1100 DE, room F4-220, Amsterdam, Netherlands.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Visser
authors.affiliation: Medical Library, Academic Medical Centre, University of Amsterdam, Netherlands.
authors.forename: Ingeborg M
authors.initials: IM
authors.lastname: Nagel
authors.affiliation: WHO/FAO/OIE and National Leptospirosis Reference Centre, KIT Biomedical Research, Amsterdam, Netherlands.
authors.forename: Marga G A
authors.initials: MG
authors.lastname: Goris
authors.affiliation: WHO/FAO/OIE and National Leptospirosis Reference Centre, KIT Biomedical Research, Amsterdam, Netherlands.
authors.forename: Rudy A
authors.initials: RA
authors.lastname: Hartskeerl
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1100 DE, room F4-220, Amsterdam, Netherlands. Electronic address: m.p.grobusch@amc.uva.nl.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D006801:Humans; D015994:Incidence; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D015047:Zoonoses / Q000453:epidemiology
keywords: Epidemiology; Leptospira interrogans; Leptospirosis; Sub-Saharan Africa; Weil's disease