The prevalence of Ventilator-Associated Pneumonia (VAP) and its associated factors among mechanically ventilated patients in Ethiopia. A systematic review and meta-analysis

Background: Ventilator-associated pneumonia (VAP) is a common nosocomial infection that occurs in critically ill patients who are on mechanical ventilation. Despite the growing number of individual studies, there is a lack of comprehensive synthesis of evidence on the prevalence and associated factors of ventilator-associated pneumonia in Ethiopia. Insight into these patterns is crucial to informing effective infection prevention strategies, optimizing patient outcomes, and guiding evidence-based clinical practice and resource allocation. Therefore, this study aimed to assess the prevalence and associated factors of ventilator-associated pneumonia in Ethiopia. Methods: This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A structured search of databases (PubMed, Google Scholar, CINAHL, Scopus, HINARI, African Journal of Online (AJOL), and Web of Science) was undertaken. The quality of the included studies was independently evaluated by two reviewers using validated critical appraisal instruments. A meta-analysis using a random-effects model was conducted to estimate the pooled prevalence. Heterogeneity among studies was assessed using the I² statistic. To identify the potential sources of heterogeneity, subgroup analyses and meta-regression were performed. Publication bias was evaluated using Egger’s test and visual inspection of funnel plots. All statistical analyses were conducted using STATA version 17.0. Results: A total of seven studies comprising 2,106 participants were included in the analysis. The pooled prevalence of ventilator-associated pneumonia among mechanically ventilated patients in Ethiopia was 24.79% (95% CI: 16.60, 32.97), as estimated using a random-effects model. Regional subgroup analysis revealed that the highest prevalence of VAP was observed in Addis Ababa (29.06%; 95% CI: 16.81, 41.31), followed by the Amhara region (24.79%; 95% CI: 16.60, 32.97). Subgroup analysis by age group indicated that the prevalence of VAP was higher among adult patients (26.90%; 95% CI: 15.68, 38.12) compared with pediatric patients (24.79%; 95% CI: 16.60, 32.97). Being male increased the odds of developing VAP by 76% compared to females (OR: 1.76, 95% CI: 1.24, 3.36), patients who undergoing tracheostomy were 6.5 times higher odds of developing VAP compared to their counterparts (OR: 6.47, 95% CI: 3.71, 11.27), and patients who ventilated more than 7 days had 5.2 times higher odds of developing VAP compared to those who ventilated fewer than 7 days (OR: 5.18, 95% CI: 2.84, 9.46). Conclusion and recommendations: Nearly one in four mechanically ventilated patients in Ethiopia develop VAP during intensive care unit admission. The risk is particularly high among males, patients undergoing tracheostomy, and those requiring prolonged mechanical ventilation. These findings underscore the substantial burden of VAP and its impact on patient outcomes in Ethiopian intensive care units. Therefore, special attention should be given to males, patients undergoing tracheostomy, and those on prolonged mechanical ventilation. In addition, strengthening infection control measures and improve the implementation of VAP prevention bundles are critical to mitigating the burden of VAP and improving patient outcomes.