Burden and associated factors of urinary tract infections among pregnant women in Ghana: a systematic review and meta-analysis

Background Urinary tract infections (UTIs) can escalate to pyelonephritis, preterm birth, and low birth weight during pregnancy, yet their burden remains poorly characterised in resource-limited settings such as Ghana, where antenatal care gaps persist and targeted screening could advance Sustainable Development Goal 3 on maternal mortality reduction. Objective This systematic review and meta-analysis aimed to estimate the pooled prevalence of UTIs among pregnant women in Ghana, identify associated factors, and profile causative pathogens. Methods This study was conducted in accordance with PRISMA guidelines. PubMed, ScienceDirect, and Google Scholar were searched for studies conducted in Ghana. Eligible studies reporting prevalence and/or determinants of UTI among pregnant women were included. Data were pooled using a random-effects model in Stata 17. Prevalence estimates were logit-transformed prior to pooling. Heterogeneity was assessed using Cochran’s Q and I2 statistics. Publication bias was evaluated using funnel plots and Egger’s regression test. Results Of 90 records identified through systematic searching, twelve studies comprising 3,031 pregnant women met the inclusion criteria. The pooled prevalence of UTI was 22.0% (95% CI: 15.0%–31.0%); however, the very high heterogeneity observed (I2 = 96.5%, p < 0.001) indicates this figure should be interpreted as an approximate summary rather than a precise national estimate. Subgroup analysis showed regional variation, with the highest prevalence observed in the Central region (56.5%; one study) and Northern region (38.6%; three studies), estimates that warrant cautious interpretation given the limited number of studies per region. Pooled prevalence was higher in studies published from 2021 onward (25.3%) than in studies published before 2020 (17.1%); no included study was published in 2020. Meta-regression identified regional location as a significant contributor to heterogeneity. None of the examined factors, including maternal age, education, parity, history of UTI, or trimester, showed statistically significant pooled associations. Escherichia coli was the predominant isolate (35.5%), followed by Staphylococcus aureus (19.0%) and Klebsiella species (13.0%). Conclusion Approximately one in five pregnant women in Ghana may be affected by UTI, although the wide confidence interval and substantial heterogeneity mean this pooled estimate should be interpreted with caution. Regional differences were observed, but most estimates were derived from single studies and require confirmation in larger, multi-site investigations. Despite the absence of statistically significant pooled associated factors, the burden remains clinically important, and strengthened routine screening alongside further region-specific research is warranted to reduce pregnancy-related complications associated with UTI.