Neonatal surgical mortality in East Africa: A systematic review and meta-analysis

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.

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.

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.

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.