Non-albicans Candida vaginal infections in sub-Saharan Africa: a systematic review, meta-analysis, and narrative synthesis of prevalence, antifungal resistance, and clinical implications among women of reproductive age.

backgroundVulvovaginal candidiasis (VVC) is a pressing gynecological issue in sub-Saharan Africa (SSA), where non-albicans Candida (NAC) species are increasingly prevalent, challenging treatment due to variable antifungal resistance patterns. Despite this, species-level NAC data from SSA remain fragmented, and no prior meta-analysis has separately quantified the population-level prevalence of NAC infection alongside the species-specific proportions of NAC among confirmed Candida isolates. This systematic review and meta-analysis was performed to estimate the pooled prevalence and determinants of NAC vaginal infections among women of reproductive age.

methodsA PRISMA 2020-compliant systematic review and meta-analysis was conducted. Four electronic databases were searched for studies published from January 1, 2015 to December 31, 2025; all four databases were searched in February 2026. Eligible studies enrolled women of reproductive age (15-49 years) from SSA and confirmed Candida species identity using validated laboratory methods. Six random-effects meta-analyses were performed on logit-transformed proportions; pooled estimates were back-transformed for presentation. Publication bias was assessed using standard funnel-plot methods.

resultsFourteen cross-sectional studies from nine countries (N = 3,587 women) met inclusion criteria. Pooled NAC prevalence was 12.56% (95% CI 8.73-17.83%; I2 = 66.4%). Pooled NAC proportion among confirmed Candida isolates was 34.98% (95% CI 25.29-46.11%; I2 = 68.8%). Species-specific proportions were: C. glabrata 16.38% (95% CI 10.72-24.27%); C. krusei 4.52% (95% CI 2.07-9.56%); C. tropicalis 4.15% (95% CI 2.12-7.91%); and C. parapsilosis 1.46% (95% CI 0.61-3.46%). These four species collectively account for 26.51% of total Candida isolates. The remaining proportion reflects other, less common NAC taxa not individually meta-analyzed due to data sparsity. Pooled estimates suggested an appreciable burden of NAC species in the region, but the magnitude should be interpreted in light of substantial between-study heterogeneity and differences in laboratory identification methods.

conclusionsNAC species contribute substantially to VVC in women of reproductive age in SSA. However, the studies included varied in laboratory identification methods, so these findings should inform surveillance and diagnostic strengthening rather than immediate empirical treatment changes. Standardized species identification and antifungal susceptibility testing with isolate-level minimum inhibitory concentration reporting are needed. REGISTRATION: PROSPERO CRD420251071725.