Clostridioides difficile in West Africa: a systematic review of the limited evidence and key knowledge gaps

Despite high diarrheal burden and antibiotic use, C. difficile infection in West Africa is insufficiently studied. This review synthesizes the limited and methodologically diverse evidence on C. difficile in West Africa, summarizing study-level findings on detection, settings, risk factors and strain characteristics to clarify current knowledge gaps and priorities for future research.

A systematic literature search was conducted through September 9, 2024, across major global and African databases. The methodological quality, strengths, limitations, and potential sources of bias of included studies were critically evaluated. Due to heterogeneity, findings were synthesized narratively rather than through meta-analysis.

Across the nine publications from eight studies identified from Nigeria, Ghana, Côte d'Ivoire, and Mali, investigators reported a wide range of findings related to C. difficile detection in both symptomatic and asymptomatic participants. Individual studies also described various participant or clinical characteristics examined within their samples, including demographics, co-infections, antibiotic use, nutritional indicators, and living conditions. Genotyping data, available from only a few studies, showed considerable ribotype diversity, with RT078 detected in a Malian isolate and RT084 most frequently reported in Ghana and Mali.

The true burden of C. difficile in West Africa remains unknown. Existing evidence comes from a small number of heterogeneous studies conducted in only four countries, providing an insufficient foundation for regional epidemiologic understanding. Collectively, these data underscore major gaps in surveillance and diagnostic capacity; addressing them will require strengthened laboratory infrastructure, increased clinical awareness, and well-designed epidemiological studies to clarify the organism's role and inform appropriate management.

This systematic review highlights the rising concern of Clostridioides difficile in West Africa, urging improved diagnostics, clinical awareness, and research to understand its burden and guide effective treatment.