Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis

Destaw Endeshaw; Amare Mebrat Delie; Ousman Adal; Abiyu Abadi Tareke; Eyob Ketema Bogale; Tadele Fentabel Anagaw; Misganaw Guadie Tiruneh; Eneyew Talie Fenta

doi:10.1186/s12873-024-00982-3

Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis

BMC Emerg Med. 2024 Apr 11;24(1):57. doi: 10.1186/s12873-024-00982-3.

Authors

Destaw Endeshaw¹, Amare Mebrat Delie², Ousman Adal³, Abiyu Abadi Tareke⁴, Eyob Ketema Bogale⁵, Tadele Fentabel Anagaw⁵, Misganaw Guadie Tiruneh⁶, Eneyew Talie Fenta²

Affiliations

¹ Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia. destawendeshaw@gmail.com.
² Department of Public Health, College of medicine and health science, Injibara University, Injibara, Ethiopia.
³ Department of emergency and critical care nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
⁴ Amref Health in Africa, COVID-19 vaccine/EPI technical assistant at West Gondar zonal health department, Gondar, Ethiopia.
⁵ Health Promotion and Behavioral science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia.
⁶ Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Abstract

Background: Abdominal injuries exert a significant impact on global morbidity and mortality. The aggregation of mortality data and its determinants across different regions holds immense importance for designing informed healthcare strategies. Hence, this study assessed the pooled mortality rate and its predictors across sub-Saharan Africa.

Method: This meta-analysis employed a comprehensive search across multiple electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari, complemented by a search of Google Scholar. Subsequently, data were extracted into an Excel format. The compiled dataset was then exported to STATA 17 statistical software for analysis. Utilizing the Dersimonian-Laird method, a random-effect model was employed to estimate the pooled mortality rate and its associated predictors. Heterogeneity was evaluated via the I² test, while publication bias was assessed using a funnel plot along with Egger's, and Begg's tests.

Result: This meta-analysis, which includes 33 full-text studies, revealed a pooled mortality rate of 9.67% (95% CI; 7.81, 11.52) in patients with abdominal injuries across sub-Saharan Africa with substantial heterogeneity (I2 = 87.21%). This review also identified significant predictors of mortality. As a result, the presence of shock upon presentation demonstrated 6.19 times (95% CI; 3.70-10.38) higher odds of mortality, followed by ICU admission (AOR: 5.20, 95% CI; 2.38-11.38), blunt abdominal injury (AOR: 8.18, 95% CI; 4.97-13.45), post-operative complications (AOR: 8.17, 95% CI; 4.97-13.44), and the performance of damage control surgery (AOR: 4.62, 95% CI; 1.85-11.52).

Conclusion: Abdominal injury mortality is notably high in sub-Saharan Africa. Shock at presentation, ICU admission, blunt abdominal injury, postoperative complications, and use of damage control surgery predict mortality. Tailored strategies to address these predictors could significantly reduce deaths in the region.

Keywords: Abdominal injuries; Meta-analysis; Mortality; Sub-Saharan Africa.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Abdominal Injuries* / mortality
Africa South of the Sahara / epidemiology
Databases, Factual
Hospitalization
Humans
Postoperative Complications
Prevalence