Clinical characteristics, etiologies, management, and outcomes of acute pancreatitis in Sub-Saharan Africa: a systematic review and meta-analysis

Abstract

Abstract Background Acute pancreatitis (AP) is a leading cause of gastrointestinal-related emergency admissions globally. In Sub-Saharan Africa (SSA), the disease has historically been characterized as a benign surgical curiosity, yet contemporary reports suggest a transition toward higher clinical acuity and significant mortality. We aimed to synthesize the available evidence to clarify the etiological drivers, diagnostic gaps, and temporal outcomes of AP in the region. Methods We systematically searched major databases (PubMed, Scopus, Web of Science, AJOL) from inception to January 2026. Observational studies reporting on AP in SSA were included. Data were pooled using random-effects meta-analysis with Freeman-Tukey transformation. Heterogeneity was explored via univariable meta-regression and subgroup analysis (Historical < 2010 vs. Modern ≥ 2010). Leave-one-out sensitivity analysis was performed to ensure robustness. Results Eleven studies comprising 1,536 patients from five SSA countries (1973–2025) met the inclusion criteria. The pooled mean age was 39.4 years (SD ± 4.4), reflecting a consistently young patient population. While a male predominance was noted (69.0%; 95% CI: 58.0–79.0%), meta-regression revealed a significant annual decline in male predominance (coefficient − 0.0066, p = 0.018). Alcohol consumption was the primary etiology (53.0%), followed by biliary disease (17.0%) and HIV-associated AP (14.0%). Notably, 44.0% (95% CI: 28.0–60.0%) of patients presented with moderately severe or severe disease, a proportion that remained stable over five decades ( p = 0.93). Despite high reported CT availability (83.3%; a study-level estimate), 5.0% of cases were diagnosed only via exploratory laparotomy. The pooled in-hospital mortality was 6.7% (95% CI: 4.4–9.0%); a descriptive decline in mortality was observed over time (coefficient − 0.00124, 95% CI: -0.00329 to 0.00081, p = 0.236), though this trend did not reach statistical significance in the exploratory meta-regression model. Conclusion Acute pancreatitis in Sub-Saharan Africa is shifting from an exclusively male-dominant alcoholic condition toward a more complex etiological profile involving rising biliary and HIV-associated disease. Although survival has significantly improved over the last 50 years, nearly half of admitted patients suffer from major complications. The persistent reliance on surgical exploration for diagnosis highlights a critical infrastructure gap. Future interventions must prioritize diagnostic standardization and expanded access to early cross-sectional imaging and critical care resources.