Mental Health Outcomes Among Pregnant Women with Viral Infections in Sub-Saharan Africa: A Systematic Review

Abstract

Background: Pregnant women with viral infections in sub-Saharan Africa face a dual burden of physical and mental health challenges. Viral infections such as HIV and COVID-19 during pregnancy can significantly impact maternal mental health, with potential consequences for both mother and child. Despite the high prevalence of both viral infections and mental health disorders in this region, comprehensive evidence on their intersection remains limited.

Methods: This systematic review followed PRISMA 2020 guidelines. We searched three databases (SciSpace, Google Scholar, and PubMed) from inception through 2026 using comprehensive search strategies. Studies were included if they focused on pregnant women in sub-Saharan Africa, included women with documented viral infections, reported mental health outcomes, and investigated prevalence, risk factors, or interventions. A two-stage screening process was employed using predefined criteria with thresholds of 4.0 for abstract screening and 4.5 for full-text screening. Data were extracted on study design, sample size, viral infection type, mental health outcomes, country/region, and key findings.

Results: From 932 initial records, 138 studies met inclusion criteria after deduplication and screening. The majority focused on HIV (n=89, 64.5%) and COVID-19 (n=45, 32.6%). Studies were conducted across 20 sub-Saharan African countries, with South Africa (n=28), Kenya (n=18), and Ethiopia (n=14) most represented. Depression was the most commonly reported outcome, with prevalence ranging from 11% to 68.5% among HIV-positive pregnant women and 13% to 86.7% among those affected by COVID-19. Anxiety prevalence ranged from 6.8% to 78%, while stress symptoms affected 43.2% to 86.7% of pregnant women. Key risk factors included HIV-related stigma, intimate partner violence, food insecurity, unintended pregnancy, and lack of social support. Protective factors included social support, partner involvement, and mental health interventions.

Conclusions: Mental health disorders are highly prevalent among pregnant women with viral infections in sub-Saharan Africa, with depression and anxiety being the most common. The burden is substantial for both HIV and COVID-19, though manifestations differ. Integrated screening and treatment approaches are urgently needed within antenatal and HIV care services. Future research should focus on scalable, culturally appropriate interventions and longitudinal studies examining the long-term impacts on maternal and child health outcomes.