Clinical outcomes of Lassa fever in West Africa: A systematic review and meta-analysis

  1. Azuka Patrick Okwuraiwe
  2. Chizaram Anselm Onyeaghala
  3. Obiageli Theresa Ozoude
  4. Muritala Odidi Suleiman
  5. Samirah Nndwan Abdu-Aguye
  6. Nkolika Jacinta Ezekwelu
  7. Tolulope Amos Oyeniyi
  8. Ayodapo Oluwadare Jegede
  9. Adaeze Elfrida Egwudo
  10. Oluchukwu Perpetua Okeke
  11. Olunuke Rebecca Abodunrin
  12. Folahanmi Tomiwa Akinsolu
  13. Olajide Odunayo Sobande

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Abstract

Introduction

Lassa fever is an acute viral haemorrhagic fever that poses a substantial public health security threat in West Africa. Due to its non-specific clinical manifestations and the absence of a reliable point-of-care test, diagnosis could be delayed, leading to severe complications and mortality during epidemics. This systematic review aimed to determine the clinical outcomes of LF in West Africa.

Methods

A systematic review and meta-analyses were performed by conducting an extensive online search using PubMed, Web of Science, Scopus, CINAHL, and Google Scholar (PROSPERO protocol CRD42024587426). Only articles written in English were included in publications from 2014 to 2024. The analysis followed PRISMA guidelines. The mortality rate of LF was pooled using a random effects model.

Results

We included 19 studies that contained data from 4177 patients hospitalized with LF of any age. Most of the studies were of retrospective cohort (16/19; 84.2%) study design and were predominantly conducted in Nigeria (16/19; 84.2%). The mortality rate was highest in a Sierra Leonean study (63.0%), whereas group-based analysis among the Nigerian studies identified Owo as having the highest mortality rate of 13% (95% CI: 06-23; I 2 =98%). The pooled LF mortality rate was 19% (95% confidence interval [CI]:10-32). The most common complications of LF are acute kidney injury (AKI) at a pooled proportion of 19% (95% CI; 13-26; I 2 =89%)), followed by abnormal bleeding at a pooled proportion of 17% (95% CI; 9-30; I 2 =98%), and CNS manifestations at a pooled proportion of 15% (95% CI; 6-32; I 2 =98%)).

Conclusion

With one out of every five hospitalized Lassa Fever patients likely to die in West Africa, accelerating the development of rapid diagnostic tests, licensed vaccines, and novel therapeutics is crucial. Strengthening community engagement, risk communication, and healthcare worker training will enhance early diagnosis and effective case management thereby reducing mortality and severe complications.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/17220051.

    Does the introduction explain the objective of the research presented in the preprint? Yes It outlined the objective of the research clearly.
    Are the methods well-suited for this research? Somewhat appropriate The method is somewhat appropriate because there is need for more clarity on the studies used for exclusion/inclusion criteria. There's need to review the duration of search (2004 to 2024) and the duration reported (2014 to 2024) in inclusion/exclusion criteria. More, the strategy for analyzing publication bias seem insufficient. For instance, consider Egger's test and Funnel plot. Also, there's need to clarify the risk of bias checklist used against the inclusion criteria.
    Are the conclusions supported by the data? Highly supported
    Are the data presentations, including visualizations, well-suited to represent the data? Highly appropriate and clear However, there's need to simplify the content for easy comprehension.
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Very clearly
    Is the preprint likely to advance academic knowledge? Highly likely
    Would it benefit from language editing? No
    Would you recommend this preprint to others? Yes, but it needs to be improved
    Is it ready for attention from an editor, publisher or broader audience? Yes, after minor changes The corrections should be implemented.

    Competing interests

    The authors declare that they have no competing interests.

  2. Version published to 10.1101/2025.01.10.24319564 on medRxiv