Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study.

OBJECTIVE: This analysis is to present the burden and trends of morbidity and mortality due to lower respiratory infections (LRIs), their contributing risk factors, and the disparity across administrative regions and cities from 1990 to 2019. DESIGN: This analysis used Global Burden of Disease 2019 framework to estimate morbidity and mortality outcomes of LRI and its contributing risk factors. The Global Burden of Disease study uses all available data sources and Cause of Death Ensemble model to estimate deaths from LRI and a meta-regression disease modelling technique to estimate LRI non-fatal outcomes with 95% uncertainty intervals (UI). STUDY SETTING: The study includes nine region states and two chartered cities of Ethiopia. OUTCOME MEASURES: We calculated incidence, death and years of life lost (YLLs) due to LRIs and contributing risk factors using all accessible data sources. We calculated 95% UIs for the point estimates. RESULTS: In 2019, LRIs incidence, death and YLLs among all age groups were 8313.7 (95% UI 7757.6-8918), 59.4 (95% UI 49.8-71.4) and 2404.5 (95% UI 2059.4-2833.3) per 100 000 people, respectively. From 1990, the corresponding decline rates were 39%, 61% and 76%, respectively. Children under the age of 5 years account for 20% of episodes, 42% of mortalities and 70% of the YLL of the total burden of LRIs in 2019. The mortality rate was significantly higher in predominantly pastoralist regions-Benishangul-Gumuz 101.8 (95% UI 84.0-121.7) and Afar 103.7 (95% UI 86.6-122.6). The Somali region showed the least decline in mortality rates. More than three-fourths of under-5 child deaths due to LRIs were attributed to malnutrition. Household air pollution from solid fuel attributed to nearly half of the risk factors for all age mortalities due to LRIs in the country. CONCLUSION: In Ethiopia, LRIs have reduced significantly across the regions over the years (except in elders), however, are still the third-leading cause of mortality, disproportionately affecting children younger than 5 years old and predominantly pastoralist regions. Interventions need to consider leading risk factors, targeted age groups and pastoralist and cross-border communities.

Pattern of disease and determinants of mortality among ICU patients on mechanical ventilator in Sub-Saharan Africa: a multilevel analysis.

BACKGROUND: The global mortality rate of patients with MV is very high, despite a significant variation worldwide. Previous studies conducted in Sub-Saharan Africa among ICU patients focused on the pattern of admission and the incidence of mortality. However, the body of evidence on the clinical outcomes among patients with MV is still uncertain. OBJECTIVE: The objective of this study was to investigate the pattern of disease and determinants of mortality among patients receiving mechanical ventilation in Southern Ethiopia. METHODS: Six hundred and thirty patients on mechanical ventilation were followed for 28 days, and multilevel analysis was used to account for the clustering effect of ICU care in the region. RESULTS: The incidence of 28-day mortality among patients with MV was 49% (95% CI: 36-58). The multilevel multivariate analysis revealed that being diabetic, having GSC < 8, and night time admission (AOR = 7.4; 95% CI: 2.96-18.38), (AOR = 5.9; (5% CI: 3.23, 10.69), and (AOR = 2.5; 95% CI: 1.24, 5.05) were predictors. CONCLUSION: The higher 28-day mortality among ICU patients on mechanical ventilation in our study might be attributed to factors such as delayed patient presentation, lack of resources, insufficient healthcare infrastructure, lack of trained staff, and financial constraints. TRIAL REGISTRATION: The protocol was registered retrospectively on ( NCT05303831 ).

Global burden of out-of-hospital cardiac arrest in children: a systematic review, meta-analysis, and meta-regression.

The incidence of out-of-hospital cardiac arrest (OHCA) and its mortality among children decreased globally over the years. However, the incidence, mortality, and its determinants are heterogeneous globally. The current study was designed to investigate the incidence of OHCA, mortality, and its determinants based on a systematic review of published literature. A comprehensive search was conducted in PubMed/Medline; Science Direct, Cochrane Library, Hinari, and LILACS without language and date restrictions. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool. A total of 2526 articles were identified from different databases with an initial search. Forty-eight articles with 138.3 million participants were included in the systematic review. The meta-analysis showed that the pooled rate of mortality was found to be 70% (95% CI: 57-81%, 42 studies, 28,345 participants). The incidence of OHCA and mortality among children was very high among children with significant regional disparity. Those children with cardiovascular causes of arrest, and initial nonshockable rhythm were independent predictors of OHCA-related mortality. This systematic review and meta-analysis is registered in Prospero (CRD42022316602). IMPACT: This systematic review addresses a significant health problem in a global context from 1995 to 2022. The meta-regression revealed that the incidence of OHCA and mortality of children decline over the years in high-income countries despite regional dispraises among individual studies. Body of evidence on the incidence of OHCA and mortality is lacking in low- and middle-income countries.

Efficacy and safety of wound infiltration modalities for postoperative pain management after cesarean section: a systematic review and network meta-analysis protocol.

BACKGROUND: Postoperative pain after a cesarean section has negative consequences for the mother during the postoperative period. Over the years, various postoperative pain management strategies have been used following cesarean section. Opioid-based analgesics and landmark approaches have negative side effects, while ultrasound-based regional analgesia necessitates resources and experience, but various wound infiltration adjuvants are innovative with few side effects and are simple to use. The efficacy and safety of each adjuvant, however, are unknown and require further investigation. OBJECTIVE: This network meta-analysis is intended to provide the most effective wound infiltration drugs for postoperative management after cesarean section. METHOD: A comprehensive search will be conducted in PubMed/MEDLINE, Cochrane Library, Science Direct, CINHAL, and LILACS without date and language restrictions. All randomized trials comparing the effectiveness of wound infiltration drugs for postoperative pain management after cesarean section will be included. Data extraction will be conducted independently by two authors. The quality of studies will be evaluated using the Cochrane risk of bias tool, and the overall quality of the evidence will be determined by GRADEpro software. DISCUSSION: The rate of postoperative acute and chronic pain is very high which has a huge impact on the mother, family, healthcare practitioners, and healthcare delivery. It is a basic human right to give every patient with postoperative pain treatment that is realistic in terms of resources, technique, cost, and adverse event profile. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021268774.

Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression.

BACKGROUND: The body of evidence showed that perioperative cardiac arrest and mortality trends varied globally over time particularly in low and middle-income nations. However, the survival of children after cardiac arrest and its independent predictors are still uncertain and a topic of debate. This study was designed to investigate the mortality of children after a perioperative cardiac arrest based on a systematic review of published peer-reviewed literature. METHODS: A comprehensive search was conducted in PubMed/Medline; Science direct, CINHAL, and LILACS from December 2000 to August 2021. All observational studies reporting the rate of perioperative CA among children were included. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool. RESULTS: A total of 397 articles were identified from different databases. Thirty-eight studies with 3.35 million participants were included. The meta-analysis revealed that the global incidence of perioperative cardiac arrest was 2.54(95% CI: 2.23 to 2.84) per 1000 anesthetics. The global incidence of perioperative mortality was 41.18 (95% CI: 35.68 to 46.68) per 1000 anesthetics. CONCLUSION: The incidence of anesthesia-related pediatric cardiac arrest and mortality is persistently high in the last twenty years in low and middle-income countries. This probes an investment in continuous medical education of the perioperative staff and adhering with the international standard operating protocols for common procedures and critical situations. REGISTRATION: This systematic review and meta-analysis is registered in the research registry (UIN: researchregistry6932).

The burden of household out-of-pocket healthcare expenditures in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: In Ethiopia, household Out-Of-Pocket healthcare expenditure accounts for one-third of total healthcare expenditure, is one of the highest in the world, and still creates barriers and difficulties for households to healthcare access and may delay or forgo needed healthcare use. Despite the presence of a few highly dispersed and inconsistent studies, no comprehensive study was conducted. Therefore, in this systematic review and meta-analysis, we aimed at estimating the pooled estimates of the burden of household Out-Of-Pocket healthcare expenditures among Ethiopian households and identifying its determinants. METHODS: We systematically searched articles from PubMed / Medline and Google scholar databases and direct Google search engine without restriction on publication period. Cross-sectional and cohort articles and grey literature published in English were included. Data were extracted using Microsoft Excel. Two reviewers screened the titles, reviewed the articles for inclusion, extracted the data, and conducted a quality assessment. The third reviewer commented on the review. Articles with no abstracts or full texts, editorials, and qualitative in design were excluded. To assess quality, Joanna Briggs Critical Appraisal Tools was used. A Forest plot was used to present summary information on each article and pooled common effects. Potential heterogeneity was checked using Cochrane's Q test and I-squared statistic. We checked publication bias using a Funnel plot. Moreover, subgroup and sensitivity analyses were performed. Meta-analysis was used for the pooled estimates using RevMan statistical software Version 5.4.1. RESULTS: In this review, a total of 27 primary articles were included (with a total sample size of 331,537 participants). Because of the presence of heterogeneity, we employed a random-effects model; therefore, the pooled burden household Out-Of-Pocket / catastrophic healthcare expenditure in Ethiopia was strongly positively associated with household economic status. The odds of facing Out-Of-Pocket / catastrophic healthcare expenditures among the poorest quintile was about three times that of the richest (AOR = 3.09, 95% CI: 1.63, 5.86) p-value < 0.001. In addition, on pooled analysis, the mean direct Out-Of-Pocket healthcare expenditures were $32 per month (95%CI: $11, $52) (SD = $45), and the mean indirect Out-of-Pocket healthcare expenditures were $15 per month (95%CI: $3, $28) (SD = $17). The mean catastrophic healthcare expenditure at 10% of threshold was also disproportionately higher: 40% (95%CI: 28, 52%) (SD = 20%). Moreover, the common coping mechanisms were a sale of household assets, support from family, or loan: 40% (95%CI: 28, 52%) (SD = 20%). CONCLUSION: Our study revealed the evidence of inequity in financial hardship that the burden of household Out-Of-Pocket / catastrophic healthcare expenditures gap persists among Ethiopian households that is unfair and unjust. To reduce the detected disparities in seeking healthcare among Ethiopian households, national healthcare priorities should target poor households. This calls for the Ministry of Health to improve the challenges and their impact on equity and design better prepayment policies and strengthen financial protection strategies to protect more vulnerable Ethiopian households. PROTOCOL REGISTRATION: The details of this protocol have been registered on the PROSPERO database with reference number ID: CRD42021255977 .

Prevalence and risk factors of psychoactive substance abuse among students in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Substance uses were seen in 18-25 years old age groups who are more than 40% world population, from which Africa was the region with the highest proportion accounting 60% in 2016. This review aimed to assess the burden of substance abuse among students in Ethiopia. METHODS: A comprehensive search was conducted in PubMed/Medline; Science direct and African Online Journal without language and date restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All cross-sectional studies reporting rate of prevalence of psychoactive substance among students were included and the rest were excluded. RESULT: A total of 545 articles were identified from different databases and 42 articles were selected for evaluation. Twenty-nine Articles with 22, 012 participants were included. The overall prevalence of psychoactive substance abuse was 32.28% (95% confidence interval (CI): 26.74 to 37.82). CONCLUSION: The review revealed that one-third of the high school and higher education students used different psychoactive substances in Ethiopia. REGISTRATION: This Systematic Review and Meta-Analysis was registered in Prospero international prospective register of systemic reviews (CRD42020146656) on April 28/2020.

Global prevalence and determinants of mental health disorders during the COVID-19 pandemic: A systematic review and meta-analysis.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) has infected more than 5 million and lost the lives of more than 300 thousand people globally. It is the first-ever deadly pandemic with a significant degree of fear, worry and concern in the population at large. Therefore, this Meta-Analysis aims to assess the global prevalence and determinants of mental health disorders. METHODS: A three-stage search strategy was conducted on PubMed/Medline, Science direct LILACS and PsycINFO databases. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. Publication bias was checked with a funnel plot and the objective diagnostic test was conducted with Egger's correlation, Begg's regression tests, and Trim and fill method. RESULTS: The Meta-Analysis revealed that the pooled prevalence of anxiety and depression 33.59% (95% confidence interval (CI): 27.21 to 39.97, 30 studies, 88,543 participants) and 29.98% (95% confidence interval (CI): 25.32 to 34.64, 25 studies, 78,191 participants) respectively. CONCLUSION: The review revealed that more than thirty percent of patients developed anxiety and depression during COVID-19 Pandemic. This presages the health care stakeholders to prevent and intervene in mental health disorders. REGISTRATION: This review was registered in Prospero international prospective register of systematic reviews (CRD42020183146).

Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression.

BACKGROUND: The body of evidence showed that there is a strong correlation between acute myocardial Injury and COVID-19 infection. However, the link between acute myocardial infection and COVID-19, the prevalence, reliability of diagnostic modalities, independent predictors, and clinical outcomes are still uncertain and a topic of debate. The current study was designed to determine the prevalence, determinants, and outcomes of acute myocardial injury based on a systematic review and meta-analysis the global published peer-reviewed works of literature. METHODS: A comprehensive search was conducted in PubMed/Medline; Science direct, CINHAL, and LILACS from December 2019 to May 2021. All observational studies reporting the prevalence of AMI were included while case reports and reviews were excluded. The data were extracted with two independent authors in a customized format. The methodological quality of included studies was evaluated using the Newcastle-Ottawa appraisal tool. RESULTS: A total of 397 articles were identified from different databases. Thirty-seven Articles with 21, 204 participants were included while seven studies were excluded. The meta-analysis revealed that the pooled prevalence of myocardial injury during the COVID-19 pandemic was 22.33 % (95 % CI: 17.86 to 26.81, 37). CONCLUSION: Our meta-analysis showed that mortality among patients with an acute myocardial injury during COVID-19 was more than four times more likely as compared to those without AMI. This necessitates a mitigating strategy to prevent and manage before its clinical outcomes getting worse.

Prevalence and outcomes of malnutrition among hospitalized COVID-19 patients: A systematic review and meta-analysis.

BACKGROUND: Malnutrition is inevitable in patients with Coronavirus Disease 2019 (COVID-19) due to its effect on the gastrointestinal system, immune system, and high metabolic activity. However, the prevalence of malnutrition and its outcomes is uncertain. This study aimed to investigate the prevalence and outcome of malnutrition among patients with COVID-19. METHOD: A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019 to September, 2020 without language restriction. All observational studies reporting the prevalence of malnutrition were included while case reports and reviews were excluded. The data were extracted with two independent authors with a customized format and the disagreements were resolved by the other authors. The methodological quality of included studies was evaluated using a standardized critical appraisal tool. RESULTS: A total of 511 articles were identified from different databases and 27 articles were selected for evaluation after the successive screening. Fourteen articles with 4187 participants were included. The pooled prevalence of malnutrition among hospitalized patients with COVID-19 was 49.11% (95% CI: 31.67 to 66.54). The odd of mortality among patients COVID-19 with malnutrition was 10 times more likely as compared to those who were well-nourished. CONCLUSION: The prevalence of malnutrition and mortality associated with malnutrition among COVID-19 hospitalized patients was very high which entails a mitigating strategy by different stakeholders to prevent and manage malnutrition and its outcomes. REGISTRATION: This systematic review was registered in Prospero's international prospective register of systematic reviews (CRD42020215396).

Survival and predictors of mortality among patients admitted to the intensive care units in southern Ethiopia: A multi-center cohort study.

BACKGROUND: The burden of life-threatening conditions requiring intensive care units has grown substantially in low-income countries related to an emerging pandemic, urbanization, and hospital expansion. The rate of ICU mortality varied from region to region in Ethiopia. However, the body of evidence on ICU mortality and its predictors is uncertain. This study was designed to investigate the pattern of disease and predictors of mortality in Southern Ethiopia. METHODS: After obtaining ethical clearance from the Institutional Review Board (IRB), a multi-center cohort study was conducted among three teaching referral hospital ICUs in Ethiopia from June 2018 to May 2020. Five hundred and seventeen Adult ICU patients were selected. Data were entered in Statistical Package for Social Sciences version 22 and STATA version 16 for analysis. Descriptive statistics were run to see the overall distribution of the variables. Chi-square test and odds ratio were determined to identify the association between independent and dependent variables. Multivariate analysis was conducted to control possible confounders and identify independent predictors of ICU mortality. RESULTS: The mean (±SD) of the patients admitted in ICU was 34.25(±5.25). The overall ICU mortality rate was 46.8%. The study identified different independent predictors of mortality. Patients with cardiac arrest were approximately 12 times more likely to die as compared to those who didn't, AOR = 11.9(95% CI:6.1 to 23.2). CONCLUSION: The overall mortality rate in ICU was very high as compared to other studies in Ethiopia as well as globally which entails a rigorous activity from different stakeholders.

Global prevalence and determinants of mortality among patients with COVID-19: A systematic review and meta-analysis.

BACKGROUND: The challenge of COVID-19 is very high globally due to a lack of proven treatment and the complexity of its transmission. The prevalence of in-hospital mortality among patients with COVID-19 was very high which ranged from 1 to 52% of hospital admission. The prevalence of mortality among intensive care patients with COVID-19 was very high which ranged from 6% to 86% of admitted patients. METHODS: A three-stage search strategy was conducted on PubMed/Medline; Science direct Cochrane Library. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. Publication bias was checked with a funnel plot and the objective diagnostic test was conducted with Egger's correlation, Begg's regression tests. RESULT: The Meta-Analysis revealed that the pooled prevalence of in-hospital mortality in patients with coronavirus disease was 15% (95% CI: 13 to 17). Prevalence of in-hospital mortality in patients with COVID-19 was strongly related to different factors. Patients with Acute respiratory distress syndrome were eight times more likely to die as compared to those who didn't have, RR = 7.99(95% CI: 4.9 to 13). CONCLUSION: The review revealed that more than fifteen percent of patients admitted to the hospital with coronavirus died. This presages the health care stakeholders to manage morbidity and mortality among patients with coronavirus through the mobilization of adequate resources and skilled health care providers. REGISTRATION: This systematic review and meta-analysis was registered in research registry with UIN of reviewregistry1093.

Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic puts perioperative providers and staff at risk of viral exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during aerosol-generating procedures, particularly in asymptomatic carriers.However, the perioperative risk for adverse outcomes in SARS-CoV-2 infected patients remain uncertain and the topic of debate. The current study was designed to determine the postoperative mortality in COVID-19 patients based on a systematic review and meta-analysis of the global published peer-reviewed literature. METHODS: A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019, to August15, 2020, without language restriction. All observational studies reporting the prevalence of mortality were included while case reports and reviews were excluded. The data from each study were extracted with two independent authors with a customized format excel sheet and the disagreements were resolved by the third author. The methodological quality of included studies was evaluated using a standardized critical appraisal Tool adapted from the Joanna Briggs Institute. RESULTS: A total of 715 articles were identified from different databases and 45 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The meta-analysis revealed a very high global rate of postoperative mortality among COVID-19 patients of 20% (95% CI: 15 to 26) and a postoperative ICU admission rate of 15% (95% confidence interval (CI):10 to 21). CONCLUSION: The unexpected high postoperative mortality rate in SARS-CoV-2 infected patients of 20% in the global literature mandates further scrutiny in assuring appropriate surgical indications and perioperative surgical safety measures in this vulnerable cohort of patients. REGISTRATION: This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.

Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: A systematic review and Meta-analysis.

BACKGROUND: The rate of ICU admission among patients with coronavirus varied from 3% to 100% and the mortality was as high as 86% of admitted patients. The objective of the systematic review was to investigate the rate of ICU admission, mortality, morbidity, and complications among patients with coronavirus. METHODS: A comprehensive strategy was conducted in PubMed/Medline; Science direct and LILACS from December 2002 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting rate of ICU admission, the prevalence of mortality and its determinants among ICU admitted patients with coronavirus were included and the rest were excluded. RESULT: A total of 646 articles were identified from different databases and 50 articles were selected for evaluation. Thirty-seven Articles with 24983 participants were included. The rate of ICU admission was 32% (95% CI: 26 to 38, 37 studies and 32, 741 participants). The Meta-Analysis revealed that the pooled prevalence of mortality in patients with coronavirus disease in ICU was 39% (95% CI: 34 to 43, 37 studies and 24, 983 participants). CONCLUSION: The Meta-Analysis revealed that approximately one-third of patients admitted to ICU with severe Coronavirus disease and more than thirty percent of patients admitted to ICU with a severe form of COVID-19 for better care died which warns the health care stakeholders to give attention to intensive care patients. REGISTRATION: This Systematic review and Meta-Analysis was registered in Prospero international prospective register of systemic reviews (CRD42020177095) on April 9/2020.

Pattern and Outcomes of Injuries among Trauma Patients in Gedeo Zone, Dilla, South Ethiopia: A 5 Years Retrospective Analysis.

BACKGROUND: Injury has become a life threatening community health problem associated with significant mortality and morbidity worldwide. The aim of this study was to assess the burden of injury in Dilla University Hospital. METHODS: Institution-based retrospective cross-sectional study was conducted from January 2015 to June 2019. Data was collected using questionnaire adapted from WHO injury surveillance guideline. Bivariate and multivariate logistic regressions were performed to determine the factors associated with hospital mortality. RESULTS: Road traffic accident was the commonest cause of injury 178(47.3%) followed by interpersonal violence 113(30.1%). Revised trauma score (RTS) < 10 (AOR=2.5; 95% CI, 1.8-25.6), Glasgow coma scale (GCS) (AOR =0.3; 95% CI, 0.13-0.5), length of hospitalization (LOS) 1-7 days (AOR=0.1; 95% CI, 0.01-0.8) and time of arrival >24hr were predictors of mortality in a patient with injury. CONCLUSION: Lower extremity injury was common and mostly associated with RTA. Pre-hospital emergency medical service system and trauma registry need to be established to decrease the burden of injury.

Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis.

BACKGROUND: Cancellation of operation on the intended day of surgery affects the efficiency of Operation Room which incurs a significant financial loss for the patient, hospital, and health care cost of a country at large. This systematic and Meta-Analysis was intended to provide evidence on the global prevalence and determinants of case cancellation on the intended day of surgery. METHODS: A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from January 2010 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting prevalence and determinants were included. RESULTS: A total of 1207 articles were identified from different databases with an initial search. Fort-eight articles were selected for evaluation after the successive screening. Thirty-three Articles with 306,635 participants were included. The Meta-Analysis revealed that the global prevalence of case cancellation on the intended day of surgery was 18% (95% CI: 16 to 20). The Meta-Analysis also showed that lack of operation theatre facility accounted for the major reason for cancellation followed by no attendant and change in medical condition. CONCLUSION: The meta-analysis revealed that the prevalence of case cancellation was very high in low and middle-income countries and the majorities were avoidable which entails rigorous activities on operation theatre facilities, preoperative evaluation and preparation, patient and health care provider communications. REGISTRATION: This Systematic Review and Meta-Analysis was registered in a research registry (researchregistry5746) available at https://www.researchregistry.com/browse-the-registry#home/.

Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis.

Hypotension during spinal Anesthesia is the most common complication with maternal and neonatal morbidity and mortality. Low dose bupivacaine with intrathecal fentanyl is recommended as strategy to prevent spinal Anesthesia induced hypotension and related complications. The aim of this systemic review is to evaluate the efficacy of low dose bupivacaine with Intrathecal fentanyl on the improvement of maternal and neonatal outcomes compared to conventional dose bupivacaine among mothers who undergone cesarean section. We conducted a systemic search of the electronic databases of Pubmed, Medline, LILACS and others with PICO strategy for randomized controlled clinical trials comparing low dose bupivacaine with fentanyl and conventional dose bupivacaine for cesarean section. Joanna Briggs Institute (JBI) standardized data extraction form was used for data extraction and finally entered into Review Manager for data synthesis. Ten Randomized trials (552) were included in this review. Incidence of hypotension was less likely in mothers who received low dose bupivacaine with Fentanyl as compared to those with conventional dose of bupivacaine alone (RR = 0.43, 95% confidence interval (CI) 0.12-0.47, ten trials, 552 participants). The review revealed that Low dose bupivacaine combined with intrathecal Fentanyl decrease incidence of hypotension.