Bacterial meningitis treatment outcomes and associated factors among pediatrics patients in Ethiopia: a systematic review and meta-analysis

Abstract

Background Meningitis remains a major global public health challenge, even though some countries and regions have made progress in controlling the disease. The rates of illness and death due to meningitis are still alarmingly high, especially among children and in low-resource settings. This review aimed to estimate the overall treatment outcomes of meningitis and identify contributing factors in pediatric patients in Ethiopia. Methods Thirteen eligible studies were included in the systematic review and meta-analysis, sourced from five databases: PubMed, Science Direct, Web of Science, Scopus, and Google Scholar, covering studies published from 2017 to 2025. The literature search was conducted from June12, 2025 to July11, 2025, whereas the last search date was July10, 2025. Data were collected using a structured extraction checklist and analyzed with Statistics and Data(STATA 14). The pooled adjusted odds ratio (AOR) was calculated to evaluate factors associated with treatment outcomes, derived from binary data in the primary studies. Publication bias was assessed using Egger’s test, Begg’s test, and a funnel plot at a 5% significance level. Heterogeneity was examined through the Cochrane Q test and I² statistics. Study quality was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Results The pooled prevalence of poor treatment outcomes in meningitis cases was 23.56% (95% Confidence Interval (CI): 16.96–30.16). No significant heterogeneity was detected among the included studies (I² = 0.0%, p = 0.997). The associated factors of poor treatment outcomes were comorbidities (AOR = 3.78; 95% CI 2.45–5.81), lack of corticosteroid therapy (AOR = 2.49; 95% CI 1.64–3.76), unconsciousness at presentation (AOR = 6.03; 95% CI 2.76–13.18), modification of antibiotic regimen (AOR = 5.08; 95% CI 2.96–8.71), malnutrition (AOR = 2.21; 95% CI 1.34–3.64), seizures (AOR = 10.92; 95% CI 5.80–20.54), severe clinical condition (AOR = 7.80; 95% CI 4.06–15.01). Conclusion Nearly one-fourth of pediatrics meningitis patients had a poor treatment outcomes. The presence of comorbidity, absence of corticosteroid use, unconscious, antibiotics regimen change, malnutrition, having a seizure, and worse clinical conditions were associated factors of mortality. To improve outcomes, special attention should be given to high-risk patients, such as those with comorbidities, unconscious, seizures, malnutrition, and critically ill patients to help reduce mortality rates. Early administration of corticosteroids alongside antibiotics is critical to obtain good outcomes.