Treatment outcome and its predictors among patients with status epilepticus in Africa: A systematic review and meta-analysis

Status epilepticus (SE) is a life-threatening emergency that requires urgent care to prevent serious complications or death. Despite treatment advances, mortality rates remain high in Africa due to various risk factors. This review aims to evaluate treatment outcomes and their predictors among SE patients in Africa.

A comprehensive literature search was conducted using various databases including African Journals Online, Hinari, Google Scholar, PubMed, Science Direct, EMBASE, Cochrane Database, Sci-Hub, and Scopus. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS) checklist. Data on study characteristics and prevalence estimates were pooled using a random-effect meta-analysis, with additional subgroup and sensitivity analyses conducted. Potential publication bias was evaluated through both visual inspection and statistical methods.

This review included 10 studies and found that the overall prevalence of mortality and neurological sequelae among SE patients in Africa was 14.67% (95% CI: 7.70-21.64) and 19.82% (95% CI: 13.01-26.63), respectively. However, significant heterogeneity was observed, influenced by factors such as geographic region, study design, sample size, and patient age. Subgroup analyses indicated that the highest mortality prevalence was reported in Western Africa at 24.61% (95% CI: 22.72-26.49), in cross-sectional studies at 17.8% (95% CI: 3.9-31.7), and among adult populations at 21.02% (95% CI: 15.30-26.74). Meta-regression analysis revealed a positive association between sample size and the log odds of SE (coefficient = 0.009, p = 0.004). Furthermore, mortality was significantly associated with hypoglycemia [OR = 5.06 (95% CI: 2.65-9.65)], bacterial meningitis [OR = 3.18 (95% CI: 1.65-6.12)], and inadequate treatment [OR = 6.29 (95% CI: 2.66-14.88)].

Our findings demonstrate a significant burden of mortality and neurological sequelae associated with status epilepticus, particularly in Western Africa and the adult population. Hypoglycemia, bacterial meningitis, and inadequate treatment were identified as independent predictors of mortality in patients with status epilepticus.