Prevalence of aspiration pneumonia among stroke patients in Ethiopia: A systematic review and meta-analysis

Abstract

Aspiration pneumonia (AP) is a serious complication among stroke patients, increasing the risk of poor outcomes and death. Although a previous review in Ethiopia attempted to estimate its burden, it had methodological limitations. This study aimed to provide an updated and comprehensive estimate of the pooled prevalence of AP among stroke patients in Ethiopia. A systematic review and meta-analysis were conducted following PRISMA guidelines. Relevant studies were identified from electronic databases and grey literature. Data were analyzed using STATA version 17 with the metaprop package. A random-effects model with Freeman-Tukey double arcsine transformation was applied. Heterogeneity was assessed using I² and Cochran's Q test. Subgroup analysis, meta-regression, and leave-one-out sensitivity analysis were conducted. Publication bias was evaluated using funnel plot symmetry and Egger's test. A total of 27 studies involving 7,120 stroke patients were included. The pooled prevalence of AP was 24.26% (95% CI: 20.76%-27.95%), with significant heterogeneity (I² = 91.96%; p < 0.001). Subgroup analysis showed significant regional variation, with the highest prevalence in Harari (39.48%) and the lowest in Addis Ababa (16.31%). Meta-regression showed no significant associations with study year, sample size, sex proportion, ischemic stroke proportion, or mean age. Sensitivity analysis confirmed the robustness of the findings. No publication bias was detected. Aspiration pneumonia affects nearly one in four stroke patients in Ethiopia, with notable regional variation, highlighting the need for targeted prevention strategies. Registration (PROSPERO): CRD42024498777.