Journal of pediatric surgery · 2026
Neonatal surgical mortality in East Africa: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Molla Yohannis Derbew, Alebel Mekdes Tsegaye, Alemu Hirut Tesfahun
Аннотация
INTRODUCTION: Neonatal surgical conditions contribute significantly to under-five mortality, particularly in low- and middle-income countries (LMICs). However, comprehensive data on neonatal surgical mortality (NSM) and its determinants in East Africa remain scarce. This systematic review and meta-analysis aimed to estimate the pooled mortality rate among neonates with surgical conditions and identify key predictors of mortality in the region.
METHODS: Following PRISMA guidelines, we searched PubMed, Scopus, EMBASE, and Google Scholar from inception to 30 June 2025. Observational studies from East Africa reporting mortality in neonates (0-28 days) with surgical conditions, regardless of operation status, were included. Data were extracted using a standardized form, and risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was performed to estimate pooled mortality rates. Predictors of mortality were synthesized narratively and via meta-regression where possible.
RESULTS: Twelve studies (n = 3451 neonates) from five East African countries were included. The pooled overall mortality rate was 25.7 % (95 % CI: 20.3-31.2 %; I2 = 90.4 %, p < 0.001). Postoperative mortality was lower at 18 % ((95 % CI: 15-21 %); I2 = 71 %, p < 0.001). Sepsis was the most consistent predictor of mortality (pooled AOR 1.70, 95 % CI: 1.20-2.40). Other predictors, such as postoperative hypothermia, prematurity, and outborn status, showed ranges across studies. Esophageal atresia and abdominal wall defects had the highest mortality risks.
CONCLUSION: Neonatal surgical mortality in East Africa is high, with nearly 1 in 4 neonates with surgical conditions dying. Disparities across countries may highlight systemic gaps in infrastructure, timely access, and perioperative care. Targeted interventions-such as sepsis prevention, thermoregulation protocols, and strengthened referral systems-are urgently needed to reduce mortality. Standardized regional registries and investment in neonatal surgical capacity are critical for equitable care.
METHODS: Following PRISMA guidelines, we searched PubMed, Scopus, EMBASE, and Google Scholar from inception to 30 June 2025. Observational studies from East Africa reporting mortality in neonates (0-28 days) with surgical conditions, regardless of operation status, were included. Data were extracted using a standardized form, and risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was performed to estimate pooled mortality rates. Predictors of mortality were synthesized narratively and via meta-regression where possible.
RESULTS: Twelve studies (n = 3451 neonates) from five East African countries were included. The pooled overall mortality rate was 25.7 % (95 % CI: 20.3-31.2 %; I2 = 90.4 %, p < 0.001). Postoperative mortality was lower at 18 % ((95 % CI: 15-21 %); I2 = 71 %, p < 0.001). Sepsis was the most consistent predictor of mortality (pooled AOR 1.70, 95 % CI: 1.20-2.40). Other predictors, such as postoperative hypothermia, prematurity, and outborn status, showed ranges across studies. Esophageal atresia and abdominal wall defects had the highest mortality risks.
CONCLUSION: Neonatal surgical mortality in East Africa is high, with nearly 1 in 4 neonates with surgical conditions dying. Disparities across countries may highlight systemic gaps in infrastructure, timely access, and perioperative care. Targeted interventions-such as sepsis prevention, thermoregulation protocols, and strengthened referral systems-are urgently needed to reduce mortality. Standardized regional registries and investment in neonatal surgical capacity are critical for equitable care.