Acute kidney injury magnitude, mortality, and associated factors among neonates in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

Acute kidney injury (AKI) is the most frequent clinical problem that occurs in neonates, and it is associated with different medical problems. Sub-Saharan Africa accounts for a large majority of global neonatal mortality due to infection, prematurity, and birth asphyxia. All these factors are the major risk factors for AKI. AKI is an emerging significant health care concern, influenced by unique regional challenges. Despite its high burden on neonates, there is a lack of compiled evidence in sub-Saharan Africa that shows the burden of AKI among neonates. This systematic review and meta-analysis should provide the pooled prevalence of AKI in sub-Saharan Africa and its significant underlying factors. We searched (Pub-Med/Medline, HINARI, Cochrane Library, PsycINFO, Google Scholar, and online archives) articles with no date restrictions. Our database search included peer-reviewed articles and grey literature. The search terms were restricted to articles published in the English language only. The meta-analysis was conducted using Stata 17, and the estimated pooled prevalence associated with a 95% confidence interval was used to report the finding. I² was used to assess the presence of significant heterogeneity among the included studies. A total of 13 studies with 4640 neonates from nine sub-Saharan African countries that met the inclusion criteria were included. In this review, the estimated pooled prevalence of AKI was 22.14%, and mortality among neonates in the included studies was 32.0%. Factors that were significantly associated with AKI were sepsis (adjusted odds ratio = 3.96; 95% confidence interval 1.34-11.66), asphyxia (adjusted odds ratio = 2.96; 95% confidence interval 1.85-4.64), low fluid intake (adjusted odds ratio = 4.88:95% confidence interval 1.63-14.55), and hypothermia (adjusted odds ratio = 2.71; 95% confidence interval 1.72-4.28). The prevalence of AKI among neonates in sub-Saharan Africa was high, and multiple risk factors affect neonatal AKI occurrence. Identification and early management of those risk factors will help to reduce AKI occurrence in the neonatal period.

Keywords: Acute kidney injury; Magnitude; Neonates; Systematic review.