Epidemiology and clinical characteristics of pediatric foreign body aspiration in sub-Saharan Africa: a systematic review and meta-analysis.

Authors

Yohannis Derbew Molla, Suleiman Ayalew Belay, Haymanot Bekele Urga

Published in

Tropical medicine and health. Volume 54. Issue 1. Sep 07, 2026. Epub Sep 07, 2026.

Abstract

Foreign body aspiration (FBA) is a significant cause of accidental death in children under three years worldwide and is perhaps the most time-sensitive emergency in pediatric medicine. While high-income countries have established surveillance systems, the burden and characteristics of pediatric FBA in sub-Saharan Africa remain poorly characterized. This systematic review and meta-analysis aims to synthesize available evidence on the epidemiology, clinical characteristics, and outcomes of pediatric FBA across the region.
We conducted a systematic search of PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar from inception to January 2026, with no language restrictions. Studies reporting original data on children (0-18 years) with confirmed tracheobronchial foreign body aspiration in sub-Saharan African countries were included. Case reports (n < 5), editorials, and studies that did not report both age and sex distribution were excluded. We performed random-effects meta-analysis using the restricted maximum likelihood method to pool proportions for outcomes reported by at least five studies, with heterogeneity assessed using the I² statistic. Pre-specified subgroup analyses were conducted by geographic region (East, West, and southern Africa). All analyses were performed using Stata version 17.
Fourteen studies comprising 748 children from eight countries (Ethiopia, Nigeria, Ghana, Mali, Mozambique, South Africa, Tanzania and Togo) met inclusion criteria. Male predominance was consistent across all studies (pooled proportion 61%, 95% CI 58-64%, I² = 3.4%). Age at presentation varied markedly. Median age ranged from 2 years (Ethiopia) to 4.5 years (Tanzania), while mean age ranged from 2.8 years (Nigeria) to 5.7 years (South Africa). In East African studies, the majority of children were under 3 years of age. Organic foreign bodies comprised 54% of cases overall (95% CI 42-66%), but with extreme heterogeneity (I² = 93%, p < 0.001) revealing distinct geographic patterns. Seed aspiration dominated in East Africa (Ethiopia 87%, Tanzania 54%), while inorganic objects (plastics, metals) predominated in southern Africa (Mozambique 62%, South Africa 62%). West Africa showed mixed patterns. Tracheal location was consistently reported across studies (15%, I² = 0%), validating anatomical reporting, while bronchus location data were highly variable due to documentation differences. Pooled mortality was 2% (95% CI 1-3%, I² = 0.01%), with pneumonia affecting 31-33% of children in adequately reported series.
Pediatric FBA in sub-Saharan Africa shows marked geographic variation, with a distinct three-zone pattern: an East African pattern (seeds), a southern African pattern (inorganic material) and a West Africa pattern (mixed: seeds and inorganic material). These findings suggest region-specific prevention strategies rather than uniform approaches.

PMID:
42706546
Bibliographic data and abstract were imported from PubMed on 08 Sep 2026.

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