Prevalence and Associated Factors of Tonsillitis in Sub-saharan Africa: A Systematic Review and Meta‑analysis

BACKGROUND: Tonsillitis is a common cause of upper respiratory tract infections globally. Still, it assumes importance in low- and middle-income nations owing to its linkage with group A Streptococcus infection and serious sequelae, including rheumatic fever and rheumatic heart diseases, among others. Despite this, there is no consolidated estimate of the epidemiology of tonsillitis in Sub-Saharan Africa, with available data scattered across heterogeneous studies. This study aimed to provide estimates of the prevalence of tonsillitis in Sub-Saharan Africa and summarize existing literature reports on risk factors. Methods: The systematic review and meta-analysis were performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 extension guidelines. Observational studies published in PubMed and Google Scholar that were conducted in African countries and reported the prevalence or incidence of tonsillitis were searched. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies. Logit transformation of the proportions was used in the random-effects meta-analysis to estimate the pooled prevalence. Heterogeneity was tested using Cochran's Q test, I² statistic, and τ². Publication bias was checked using the funnel plot and the Egger's test. Meta-regression was used to compare the results among the countries. RESULTS A total of thirteen studies conducted in ten African countries fulfilled the criteria for inclusion, with twelve contributing to the quantitative meta-analytic estimate. The pooled logit prevalence was − 1.17 (95% CI: −2.37, 0.03), corresponding to an overall tonsillitis prevalence of approximately 23.6% (95% CI: 8.5%-50.7%). Heterogeneity was high (99.4%,p < .001). Meta-regression analysis, adjusting for country, found no significant effect (p = .960). Plot inspection indicated possible asymmetry, yet Egger test results found no publication bias (p = .479). Reported risk factors included younger age, crowding and close interpersonal contact, poor hygiene practices, and bacterial etiology, particularly Group A Streptococcus. Conclusion Tonsillitis is a serious public health problem in Sub-Saharan Africa, and the corresponding prevalence rates are comparable to those in other developing countries worldwide. However, Substantial heterogeneity and limited geographical representation restrict the generalizability of the pooled estimates. Future studies in the community setting are recommended.