Prevalence of preoperative anemia in Ethiopia: a systematic review and meta-analysis

Preoperative anemia is a significant public health problem, as it is associated with a higher rate of perioperative complications, longer hospital stays, and increased mortality. To date, no pooled estimate from available Ethiopian hospital-based studies has assessed the prevalence of preoperative anemia and its determinants. This review aims to estimate the overall prevalence of preoperative anemia and its associated factors in the country. Relevant publications were identified using PubMed, Science Direct, Google Scholar, the Directory of Open Access Journals, and African Journals Online. Statistical analysis was performed using STATA Version 17. The quality of each included study was evaluated using the Joanna Briggs Institute checklist. Egger’s regression test statistic and a funnel plot were utilized to detect any potential publication bias. Findings are presented as pooled prevalence and odds ratios, with 95% confidence intervals. Thirteen studies (cross-sectional and cohort) involving a total of 8578 adult surgical patients were included in the final analysis. The overall prevalence of preoperative anemia in Ethiopia was 36.32% (95% CI 28.71–43.93%), with a significant between-study heterogeneity ( I 2 = 100%). Factors associated with higher odds of preoperative anemia include being classified as American Association of Anesthesiology physical status 2 or higher (pooled OR = 4.45; CI 2.13–6.77), a history of malaria infection (pooled OR = 3.09; CI 2.09–4.09), a history of malignant disorders (pooled OR = 4.35; CI 2.58–6.12), and a history of surgery (pooled OR = 2.76; CI 1.15–4.38). This meta-analysis reveals a high prevalence of preoperative anemia among surgical patients in Ethiopia. This implies that preoperative anemia and those factors identified as having higher odds of preoperative anemia should be screened. Furthermore, a plan for perioperative blood management has to be in place. PROSPERO CRD420251020081