Congenital diaphragmatic hernia in Sub-Saharan Africa: a scoping review of presentation, management strategies, and outcomes

Abstract

Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that allows abdominal organs to herniate into the thorax, resulting in pulmonary hypoplasia and pulmonary hypertension. Despite morbidity and mortality associated with CDH, the available evidence has not been comprehensively synthesized in sub-Saharan Africa (SSA). This scoping review mapped the clinical presentation, management, and outcomes of CDH in SSA. We searched PubMed, Scopus, Web of Science, Embase, African Journals Online, and Google Scholar for studies published between January 2011 and March 2026. Eligible studies reported the clinical presentation, management, or outcomes of CDH in SSA and were in English or French. Findings were synthesized narratively, and study quality was appraised using the Joanna Briggs Institute critical appraisal checklists for case reports and case series. Sixteen studies comprising 55 children from nine SSA countries were included. No patients were reported to have received a prenatal diagnosis. Age at presentation ranged from birth to 8 years. Bochdalek hernia was the predominant type (44/55); 35 (63.6%) defects were left-sided, 12 (21.8%) were right-sided, 2 (3.6%) were midline or central, and laterality was unspecified for the remainder (6, 10.9%). Respiratory symptoms were the most frequently reported presenting features, although gastrointestinal symptoms were also described. Plain chest or thoracoabdominal radiography was the most commonly reported initial imaging modality. Surgical repair was reported in 14 studies, most commonly by open abdominal repair; thoracotomy was used for an intrapericardial hernia, and one South African series reported laparoscopic repair of Morgagni hernia. Mortality was reported in four studies, with deaths concentrated in severe neonatal presentations. Postoperative outcomes were favourable, but follow-up beyond discharge was inconsistently reported and, where available, ranged from 2 weeks to 3 years. Although the evidence base is small and fragmented, this review suggests favorable outcomes for CDH in SSA. However, these findings should be interpreted cautiously given the likelihood of under-reporting. Future multicenter studies with longer follow-up are needed to better characterize CDH in the region.